Physician-Assisted Suicide and Euthanasia II

Arguments Worth Considering

A Divisive Debate

Polls: Position on abortion strongly predicts position on PAS/VAE

Polls: “Religiosity” strongly predicts opposition to PAS/VAE

Significant drop in support in minority communities vs. whites

Good arguments?

Debate seems to make little progress; same charges repeated

Few authors as honest and candid as Kamisar: try hard to identify the strongest reasons in opposition to one’s own position and deal frankly with them

Concerns Worth Hearing

Minority communities Disability rights community Still: must be careful not to

stereotype all as agreeing

Minority concerns

Lack of trust in medical establishment “How come we have had unmet health

care needs in our neighborhood for years, and when you finally show up, it’s to advocate our right to die?”

Disability Concerns

Distrust of medical establishment– Good will toward persons with disabilities– Ability to make accurate prognoses

Allowing person to die because of a disability sends “wrong message”

Concerns with Concerns

Objections apply equally to forgoing treatment, PAS, VAE

Does this position require that persons with disabilities devote their lives and health to “the cause” and not their own goals and needs?

NYSTF Position Paper

“Safeguards” of proponents assumes ideal conditions– Choice of medical care options– Adequate pain management, hospice– Quick access to expert psychiatric care– Basic social support: housing, family, etc.

Too many today lack some or all of these

“Anti-Hospice” Argument

Claim: Allowing PAS will reduce felt need to fund and expand hospice programs

With less availability of hospice will have even more people in future seeking PAS (vicious cycle)

“Anti-Hospice” Argument-?

Data from Oregon show major expansion of hospice

Most proposals to legalize PAS call for more, not less use of hospice as part of “safeguards”

Hospice programs per se do not prevent all requests for PAS (Oregon)

“Quill’s Paradox”

T. Quill: May reduce the number of patients seeking PAS by openly permitting PAS

Claim: Today many terminal patients commit suicide privately because they know physicians cannot legally help them

“Quill’s Paradox”-- cont.

If PAS legal, patients might seek physician’s assistance

Physician could then identify and treat depression, uncontrolled pain, etc.

Treatment of these problems may reduce continued requests for death by as much as 8 of 9 (Netherlands)

Argument from Frequency

Best data show that legal prohibition does not eliminate PAS/VAE

We have little way of knowing whether more “abuses” occur because PAS/VAE is underground practice

Philosophers: unfairness-- well-connected get PAS/VAE whether legal or illegal

Medicalization Argument Claim: A major problem in society today

is expecting medical technology to solve problems which are really social problems (“medicalization”)

Legalized PAS is a way of inappropriately “medicalizing” dying, when real comfort comes from social, emotional, and spiritual support and “working thru”

Medicalization Argument-- II

Common for PAS advocates to cite loss of control of dying process in hospital, etc. as reason

But legalizing PAS with stringent safeguards places control of the process largely in hands of physicians

Inconsistency, or hidden motive?

Medicalization Argument- III

If I had to commit suicide all by myself, as way out of terminal illness, I might reaonably shrink from the act

BUT if I can use the physician as a symbol of “blessing” or “sanitizing” the process I may be encouraged to go thru with it

Medicalization: Rebuttal

If I try to commit suicide on my own I may botch it, or else use messy means which will traumatize family

Wishing to avoid suffering and leaving cruel memories among my family are hardly bad reasons to seek physicians’ help

Chabot Case

Netherlands Dr. Chabot consulted 8 colleagues

before assisting suicide of Mrs. B who was incurably depressed and begged for help to die

Court: Technically guilty because none of 8 actually interviewed patient

Court: Mental illness = physical

Chabot Case-- Concerns

Did Dr. Chabot truly believe that suicide was the best medical option for Mrs. B?

If not did Mrs. B in effect blackmail Chabot into PAS by her threats to commit suicide on her own?

Shows major division between “civil rights” and “physician discretion”

Hardwig: Sympathetic View

Traditional wisdom (autonomy): Worry if patient wishes to die because feels a burden to family

Could be a sign of coercion or undue influence

My decision to die ought to reflect my individual best interests not concerns of family

Hardwig: Sympathetic View- II

Hardwig: This view portrays family as fundamental conflict of interest rather than loving unit on which all of us depend

Truth is that a chronically ill elderly person can be a severe burden

Hardwig: Sympathetic View III

Case from Moyers: Woman promised mother never to put in nursing home

In caring for mother at home woman lost job, home, car, insurance

If mother could have predicted, should she have extracted promise?

Hardwig: If I did that to my family, maybe it would be wrong